For intubated intensive care unit patients confined to a bed for any significant period of time, meaningful early mobilization and sedation minimization are key elements in reducing morbidity and mortality, hastening recovery and improving quality of life by preserving cognition and strength. However, when breathing tubes, naso/orogastric tubes, intravenous (IV) lines and other medical devices are in place, preventing removal (e.g., self-extubation) of such devices can also reduce morbidity and mortality in, e.g., an intensive care unit (ICU). In order to prevent removal, restraints that drastically restrict the patient's range of motion are often used and sedation is then administered to reduce the anxiety of being unable to move. Caregiver personnel are reluctant to loosen or remove restraints because of the dire consequences of premature medical device disconnection, thereby presenting a dilemma in balancing these competing concerns.
Various types of restraints have been employed in an attempt to permit a reasonable range of motion while still protecting against device removal by the patient. However, existing restraint systems that do allow for reasonable motion still do not provide reliable or sufficient protection against device removal, nor do they allow changeable and graded levels of restraint to follow a patient's changing capabilities such that a mandate of minimum patient restraint is continually followed. For example, mitt restraints are often ineffective as patients can still disconnect themselves by pressing the mitts together. In fact even with wrist restraints, if patients are awake, as is often desirable, they may be able to move a tube they want to disconnect toward the tied hand rather than the hand to the tube. Often this is done in a state of stupor, but any further awakening of the patient can cause extreme anxiety with the realization that they are tied to a bed. Elbow immobilizers or arm boards are also employed, but awake patients may be able to disconnect themselves from such restraints. The best restraints are completely ineffective if an awake or semi-awake patient is able to disconnect them. Other problems with these types of restraints include obscuring of potential IV sites, obstruction of full arm skin assessment, joint fixation, and nerve palsies. Creation or worsening of pressure sores, which accounts for significant morbidity in the intensive care patient given that merely edema without device contact can cause skin tears, is also a concern with any device that has continued contact with a patient's skin. Difficulties with existing systems can burden ICU staff, who may be required to spend more time watching one patient to the detriment of another and to their documentation and medication dispersion duties.